Hospital reps. present at Boston conference
Representatives from St. Mary’s and Clearwater Valley Hospitals and Clinics were invited to present on the work they’ve been doing transitioning to medical home clinics these past two years.  The first national collaborative meeting of the Safety Net Medical Home Initiative was held in Boston, March 7 and 8th.  The SMHC group was asked to present and facilitate a 60 minute discussion relating to rural and frontier clinics.  The CVHC team did a poster presentation on improving patient access to services using telemedicine.  Over 275 people attended the conference, including other medical home facilitators, health center board members and guests of the funding organizations. Representatives from Clearwater Valley and St. Mary’s Hospitals were invited to present at a national Medical Home conference in Boston this month.  Pictured are Pam McBride, CVHC/SMHC Chief Grants Officer, Dr. Michael Meza, Dr. Andrew Gilbert and Dr. Vanessa Brown.
CVHC/SMHC attendees included family practice physicians, Dr. Michael Meza, Dr. Vanessa Brown and Dr. Andrew Gilbert, as well as Pam McBride Chief Grants Officer and project manager.
Five states across the nation are included in the four year, $6 million national demonstration project funded by The Commonwealth Fund and other eight other co-funders, including the Blue Cross of Idaho Foundation for Health.  The initiative is led by Qualis Health in partnership with the MacColl Institute for Healthcare Innovation.  CVHC and SMHC are two of the 13 participating practices in Idaho.  These include two family residency programs in Boise and Pocatello and community health centers in southern Idaho.   The Idaho Primary Care Association, Boise, serves as one of the five Regional Coordinating Centers. 
“Both presentations and subsequent discussions were informative not only for our audience members, but for us, as well,” said McBride.  “We learned a lot about what other clinics are doing to transition their primary care clinics to patient centered medical homes.  Sometimes it feels like herding cats, but we’ve made progress over the past two years and will continue to make changes that will benefit area patients.”
Goals of a medical home include improving the efficiency and quality of care through increased patient education.  According to Dr. Andrew Gilbert, SMHC physician, the Orofino, Cottonwood and Kamiah clinics have installed flat screen TVs that will show healthcare tips while patients wait to be seen.  “We’re also incorporating patient printouts into our clinic EMRs so they will immediately print patient education information when a diagnosis is inputted into their electronic medical record.  We can give that to our patients during their visit.  We’re also working on a new website that will include patient education materials.  Some recent grants we’ve received focus on improving outcomes for people with diabetes and congestive heart failure which also means greater emphasis on patient education to help them manage their conditions.”
One focus area for the initiative is formation of primary care teams.  Dr Vanessa Brown, CVHC physician, has spearheaded those efforts.  “We’ve made great strides at both SMHC and CVHC when it comes to empanelment.  Both medical staffs have formed teams that familiarize themselves with one another’s patients so if a provider is not available for their patient on that particular day when their patient needs to be seen then another provider who is familiar with them can step in. Of course, that physician will keep the original provider closely informed until he or she sees their patient again.  We’ll be talking more about that with our patients in the near future, but it addresses one of the complaints we hear most often concerning limited availability of a person’s personal provider.  Of course, the patient will always have the right to wait until their provider is available rather than seeing a member of the team.”  Dr. Brown will be presenting on a national webinar about empanelment later in March.
According to Dr Michael Meza, CVHC physician, other staff are also involved on the teams, including the nursing staff and admit personnel.  “We listened to our patients and have moved our clinic switchboard from the upstairs reception area to downstairs so the admit staff can focus on the patient rather than simultaneously fielding telephone calls. We’ve added coffee carts in our reception area and by our outpatient lab draw room.  We’re making lots of little changes that add up to more sensitive patient care. As we move to an electronic medical record system, we’re looking to adjust staff roles to increase our efficiencies so we can spend more quality time with our patients.”  Dr. Meza presented on a national webinar about patient support last fall. 
The medical home teams at each facility involve nursing and reception staff, in addition to health care providers.  “The timing for the medical home initiative couldn’t be better because many of our staff are designing our electronic medical records system and we’re all on board to make it reflect our medical home initiative goals.  Our EMRs will reduce medical errors and really increase our efficiencies so we can spend more quality time with our patients,” said Dr. Meza, who also serves on the CVHC medical home initiative team.
 “We are midway through the grant and are extremely honored that we were selected to be presenters in Boston.  The patient centered medical home model for primary care is gaining acceptance throughout the nation as the best way to provide health care in both urban and rural settings.  The purpose of this initiative and the conference is to provide input on the best ways to transition to that model of care,” said McBride.  “We’re really at the forefront of that process.  We’re serving as the model for clinics who are hoping to learn from us.”

Clinics EMR initiation underway
Nationally, there’s a lot of discussion revolving around the initiation of patient Electronic Medical Records and locally it’s about to happen in the St Mary’s Hospital clinics.  SMHC and Clearwater Valley Hospitals and Clinics are at the EMR forefront when compared to other rural hospitals and clinics.  “We began the process a number of years ago when we digitized our medical images, our lab reports, billing procedures and scheduling.  Now we’re taking the next step and creating patient records using electronic input during clinic visits,” said Stephanie Wagner, SMH Clinics Manager.  “Our providers will be bringing a notebook computer in the exam room and inputting health history information, prescriptions, their visit notes, and other information.”Dr. Andrew Gilbert, SMHC Chief Medical Officer, shows one of the new notebook computers that will be used by the healthcare providers during patient visits as the clinics begin initiating patient electronic medical records.
Wagner warns patients that their visit may take a little longer than usual and there may be short waits as the providers become accustomed to the electronic system.  “We’ve been staggering the training on the new EMR software system so our clinics can remain staffed and continue to meet our patient needs,” said Wagner.  “Not all the providers are trained yet, but eventually we’ll be using the system during every visit in each of our clinics.”
The Centricity software was engineered by General Electric. Although there are a variety of software packages available, staff from both SMHC and CVHC reviewed them and selected Centricity as the one that would best meet their needs and the needs of the patient.  It has the capacity to generate patient notices for necessary screens or lab work.  It also can confidentially send lab and test results. 
“It will be awhile before all aspects of the system are up and running.  Our ‘go live’ date for SMHC is in April.  We began testing the system at CVHC earlier this year to work out any bugs,” said Drew Johnson, Director, Information Systems at both facilities.  “Eventually we’ll have a patient portal on our website so people can confidentially access their own medical records.  That’s a ways down the road, but with information technology we’re always looking at how best to serve patients now and how to best serve them in the future.”
The hospitals are focusing on achieving ‘meaningful use’ status defined at the federal level in order to qualify for reimbursement for purchase of the system.
“We’re excited about what EMRs will mean for our patients,” said Dr. Andrew Gilbert, SMHC Chief Medical Officer  “It’s a gradual process, but the results will help us, as health care professionals, provide the best care possible.  We’ll have instant access to patient information including their prescriptions, lab results, medical history, etc.  Appointments may take a little longer and there may be some delays while waiting for an appointment.  I hope everyone will be patient with the process.”

Cottonwood, Idaho 83522


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